Stop Placing Nonviolent Patients in Nursing Homes, Judge Rules

New York health officials erred in placing thousands of nonviolent people with mental illness in private nursing homes rather than in independent living situations that provide needed psychiatric care, a federal judge ruled last month.

Nicholas Garaufis, a federal judge of the U.S. District Court in Brooklyn, ruled on September 8 that the state was violating the Americans With Disabilities Act by placing more than 4,300 people with mental illness in private New York state nursing homes. The ruling in Disability Advocates Inc. v. Paterson held that the city has failed to provide the patients' psychiatric care “in the most integrated setting,” which violated the terms of the U.S. Supreme Court's 1999 decision in L.C. and E.W. v. Olmstead. The Court ruled that the unjustified isolation of individuals with disabilities away from their communities is a form of discrimination based on disability.

“The decision affirms that the Olmstead integration mandate applies wherever people with mental illnesses are served by the state,” said Jennifer Mathis, deputy legal director of the Bazelon Center for Mental Health Law and co-counsel in the case. “Olmstead would be far less significant if it covered only public institutions.”

The ruling came even though the state of New York has labeled the nursing homes as “community-integrated.”

Despite that, Garaufis noted that nursing-home residents with mental illness had virtually no privacy, were even more restricted than patients in psychiatric hospitals, and were not allowed to develop skills to become self-sufficient.

“This ruling shows that when a state provides mental health services, it must be in the most integrated setting possible,” said Ira Burnim, the Bazelon Center's legal director. “We are extremely pleased with the ruling and the opportunities it offers thousands of New Yorkers. States around the country should take note.”

The center is involved in similar legal challenges in Connecticut and Illinois.

An additional benefit of moving the patients, the judge said, is that locating nonviolent patients with mental illness in private apartments and providing them needed psychiatric care would cut Medicaid costs, compared with the high cost of nursing-home care. The annual cost of serving a resident in community-based supported housing, when Medicaid costs are considered, is on average $7,693 cheaper than serving that person in a nursing home, according to the court.

The ruling did not indicate what specific actions the state must take to come into compliance with federal law; however, the judge plans to determine that in the future.

Advocates for people with mental illness filed the class-action suit in 2003 to seek alternative services for adult-home residents including, especially, the creation of “supported housing,” such as rental apartments, where rehabilitation and treatment services are provided as needed. The state already licenses and provides funding for such supported housing but it has not created enough to accommodate the number of people who need them.

The ruling comes in the wake of press reports that the placement of people with mental illness in nursing homes is a growing trend nationwide. An Associated Press report early this year found that people with mental illness are a growing percentage of the nation's nursing home population: about 9 percent in 2008 compared with 6 percent in 2002. That report cited a shrinking number of psychiatric hospitals as one reason for the trend.

The ruling in Disability Advocates Inc. v. David A. Paterson is posted at<www.bazelon.org/pdf/DAIruling9-8-09.pdf>.▪